tale of 2 biopsies

55, 150 lbs, work out regularly, over all good health, have had BPH for 5 years.

PSA started jumping around in 2013, 2014

July 2014, 5.6 PSA, had Biopsy in Aug of 2014 ---- Gleason 6, pursued watchful waiting
MRI in November of 2014----negative for cancer
MRI November of 2015--was told is showed "significant change" on left side of prostate, and cancer had grown fast, surgery recommended. Was told it has likely spread through out the prostate.
November of 2015: PSA 4.6
I held out for another Biopsy

Just got the results from the biopsy from 1/13/16 (surgeon that did it, took extra care to hit the left side of prostate where the MRI showed change). NEGATIVE BIOPSY--no cancer found.

Surgeon still saying I need to get this taken out----playing Russian Roulette.
I am thinking of just going back to watchful waiting. What do you guys think? Any advice?

If he was going to tell you to take it out regardless of the results....I wonder why he did the biopsy?

If you were good with it before, and your good with it now....do another MRI in 6 mos. (or so).

There's other tests as well. Others will be along that can offer more...

I am reading your stats and thinking "how strange" A year ago you were positive G6 with PSA 5.6 and now you have PSA of 4.6 and negative biopsy, and surgeon says "fast growing cancer" Hmm, I don't get it.
I can see why you don't want to jump into having surgery.

Thanks for the replies guys.

Clarifications: The 2nd MRI said it was cancer --no cancer on 1st MRI that was done after 1st biopsy that said i was a Gleason 6.

The 2nd PSA in November of 2015 was 3.77---- NOT 4.6 as i had originally posted, so PSA has gone DOWN.

The 2nd Biopsy was done at MY insistence... I was told there is no point in having it.

Well Gee, glad I did have it.

I know they did not 'hit' a cancerous area, but still, surgeon said he did hit area where MRI had changed, several times. I mean what are the odds? I am wondering if MRI is showing benign changes.

Any one know of a good pathologist I can have biopsies sent to?
thanks

I agree with Halbert on sending your slides to Epstein for a second opinion. It is possible he could upgrade some of your cores from "negative" to G6. That said, you likely would still be able to do Active Surveillance then if you desired. Looking on the other side of the coin, we've had at least one poster here that had a G6 biopsy, had surgery and the post-surgical pathology showed no cancer.

So the uro wanted to do surgery solely on the basis of the suspicious biopsy? That sounds...odd to me. Only a biopsy can confirm cancer and your biopsy seemed to target the suspicious area.

What Sheepguy said. And that's the big problem. You just don't know. Getting a second opinion on both the slides AND the MRI is a good idea.

Just like the early days of ultrasound. At Cornell we looked at a lot of woodchuck livers , looking for liver cancer and subsequent biopsies it took a lot of US before it looked like anything on ultrasound. Of course the technology got better as we went so that helped, but still , you had to know what you were looking at.

"Was told it had likely spread throughout the prostate."

What the heck does that mean and if it were true one would have to believe a biopsy wouldn't miss it.

My MRI showed alot of stuff that could be interpreted differently as different things. (Probably 70% of it appeared abnormal) My second opinion radiologist told me, in his opinion, it's inflammation, not cancer. (He also mentioned a 2 or 3 other things it could be...All benign and none of which I'd ever heard of before). I asked him how he came to that conclusion. He told me it was his opinion that a biopsy could not possibly miss that much cancer. (Turns out he was right).

I believe getting a second opinion on biopsy and MRI images is always a good idea.


Brian....did Epstien read the August '14 biopsy? If not...i might would send those to him. Its possible you might not even have cancer.

Not so, sheepguy. He's had his own firm for many years and has a well trained team. Neither he nor Epstein looked at every slide. The important part is having eyes that are well-trained and dedicated to prostate only. Like all good professionals, we train people to take over our job.

You can try Daniel Margolis at UCLA - probably none better.

- Allen

As my hubby and I have learned well from the members of this forum. "Biopsy trumps MRI", someone here told this to us with others in agreement. I also agree with the 2nd look from Dr. Epstein.

First of all, congrats on the "no cancer" from Bostwick. I know you're in a weird situation, but that's a very good to hear.

As to your next steps, based on what you know now there's only one warning sign and that's the MRI. I'd want to know a heck of a lot more about what it's showing before I had any kind of radical treatment--surgery or radiation. While I'm not doctor and I don't know what the "significant change" is on the MRI, it doesn't seem like anything to hang your hat on.

PS Lots of radiation guys here (myself included). Most of us have done quite well (myself included). But I'd still want to get at the heart of what's going on before exploring radical treatment. I think there's a good chance you don't need it or that's it's optional for you.

brian3222 said...
August of 2014 Biopsy---Gleason 6.
Jan of 2016 Biopsy ---negative.

Surgeons are still telling me that i need to take it out.....
I am still holding out for a MRI guides biopsy of that area.....

Or Fusion biopsy (both are targeted), and Fusion may be easier to schedule.

Targeted biopsy makes sense to me. And if targeted showed nothing more than a Gleason 6, I believe I would go for a full mapping biopsy prior to any form of treatment.

Not to mention your PSA is going down, not up.

If I were in your place, I would certainly want more information before seeking treatment which may or may not be needed. We had a poster here not that long ago whose father was a Gleason 6 but the post surgery pathology showed no cancer in the removed prostate.